Mainstay Insurance

We are as vigilant as possible in reviewing renewal data, and looking for high paramedical claims that may indicate fraud.  We educate clients, and have several each year that inform us of suspicious behaviour by employees (often TOO GOOD TO BE TRUE offers).

We call fraud lines from time to time to report, and often make plan design changes (read as benefit cuts) in an attempt to protect employers.  The story below, shows how big the problem can become…

One of the fired employees said she began claiming for physiotherapy she did not receive because she was paying more each month into a benefits plan than she was actually using.

In what could be one of the largest and longest-lasting benefits fraud schemes ever discovered in Canada, a Toronto geriatric hospital has dismissed approximately 150 employees for falsely claiming as much as $5 million in benefits over an eight-year period.

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From time to time we find new technology launched into the employee benefits space, that while very cool, doesn’t really solve a problem.  It’s a great idea, but you can’t see an employer paying for it, unless they fit just a certain set of conditions (and few clients are working at remote mining towns in northern Ontario).

Telemedicine is one of those things.  Sure, having a doctor on your phone can save a visit to (and hence some lost time), but do employers want to pay when the current system works pretty good for free (and heck, they can go after hours and on weekends…right?)

Well now here is a fee for service model that can be used by anyone.  Don’t have a family doctor?  Wish you could do a quick consult but have a deadline and can’t afford to wait at the doctors office?  Are out of town at the cottage or a business trip and not close to your doctor?  All these situations may make this an option for you…

Appointment pricing ranges depending on the type (generally $25-$50). Appointments are paid by the employee, but can be covered by health spending accounts and a complete receipt is provided for reimbursement.

If you’d like to make this available AND pay for it for all your staff, yearly and monthly membership plans are available, just let us know and we can set you up..

For more information, check out TIA Health at  https://tiahealth.com/

This article came across my desk and I thought it well written and hit the points where we often see things go wrong, especially with smaller employers where HR might be part-time or absent.

The decision to terminate an individual’s employment is not an easy one. At times, however, whether due to economic pressures, or poor performance, it may nevertheless be necessary.

The process your organization follows when carrying out a termination of employment is important. It can have a big impact on the affected individual and, if done carefully, can reduce the potential risk of liability to your organization.

Here are our top five things that any employer should take into consideration when looking to dismiss an employee….

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Employers with employees in Ontario often ask us to confirm legislative requirements under various employment statutes, including mandatory postings, training, and policies under the Employment Standards Act, 2000, the Occupational Health and Safety Act, and the Accessibility for Ontarians with Disabilities Act.

To make this information conveniently available, the Littler Toronto assembled these requirements in a single publication, which was originally posted in August 2017. An updated version of this publication was provided to clients in March 2018 and the newest version can now be accessed through the link below.

These apply to ALL Ontario Employers.  Make sure you are compliant.

Ontario Mandatory Postings

The Ontario Ministry of Labour is adding events to educate Ontario employers.

If you are interested and would like to register, please follow the link below

Free webinar on hours of work and overtime – July 24

Do you know what the hours of work and overtime rules are in Ontario? What about how to calculate overtime pay? Join ministry staff for a one-hour overview beginning at 10:30 a.m.

Register online

I have had the great privilege of being a part of the Sanofi Canada Healthcare Survey Advisory Board for the past few years.  Through this group I get to meet some great people in a variety of roles including; consultants, insurers, plan sponsors, associations, medical, pharmaceutical, as well as those in the publishing field that make it all happen behind the scenes.  These are people that the average benefits advisor never gets the chance to meet let alone spend some time with.

The learning for  the survey results as well as the exchange itself, makes me much better as an advisor and as an educator in our industry. Thank you Sanofi, for making the survey possible and letting me be a part of it.

Tale a few minutes to read the report highlight.  Some of the results that the employers and employees share can be quite enlightening.

While just half (49 per cent) of plan members said changes were made to their benefits plan in the past two years, 72 per cent of plan sponsors reported they made changes, according to the 2019 Sanofi Canada health-care survey.

Read the Benefits Canada article HERE    Get the 2019 Survey HERE

This case is from late last year but provides a great example of the amount of notice that may be required for changes in “conditions of employment”.  As employers make changes to benefit plan offerings, employment contracts (contract staff, independent contractors), or major changes in location etc., they may wish to keep in ind that notice may be as long as notice for termination.

Published on July 11, 2018 User Stringer LLP
In Lancia v. Park Dentistry, the Ontario Superior Court confirmed that employers can change the fundamental terms of an employee’s employment, without providing consideration, so long as they take appropriate steps to provide reasonable notice of the change coupled with notice that employment under current terms would terminate at the end of that notice period…

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If you are a Mainstay client, then your risk (mentioned in the article) is a bit lower than with most.  You likely have an insured benefit plan (over ASO) and few of our clients reduce or remove drug coverage. That said, sometimes due to rising costs, a drug cap can be appropriate as a last ditch effort to maintain a plan, and risks can arise.  In some cases insurer changes beyond an employers control can cause delays and in some cases, moving to an HSA only plan or dropping a plan altogether can create a risk if someone is on a high cost drug.  All that said, we are lucky in Ontario to have the Trillium Drug Program that can assist in many of these situations..

Drug plan design changes are often unavoidable, whether they’re due to a carrier modifying contracts across the board or an employer looking to manage ballooning costs.

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If you are an Ontario employer and pay WSIB premiums, you should know there are some changes coming for 2020 as to how they calculate the rate you pay.  We’ve included an article below, but the WSIB site also has info on the upcoming changes.

https://www.wsib.ca/en/businesses/premiums-and-payment/rate-framework

Ontario’s Workplace Safety and Insurance Board is changing how premium rates are calculated for almost 300,000 registered businesses across the province.

The WSIB hasn’t changed its rate setting scheme for more than 20 years, says Pamela Steer, the board’s chief financial officer. “We really looked at how we could change the offering to our customers, such that it would make more sense for the modern day. So leveraging technology, big data and risk analytics in order to more transparently provide employers with their premium rates and also to base it more on the risk they present.”….

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If you are reading this, you are probably a Mainstay client that likely has travel coverage through your employer plan, so this may have no, or next to no effect on you.  Where it MAY have an effect on you is… If you are an Ontario resident with employee benefit travel coverage, and have an out of country claim, then you will no longer need to apply to the province for coverage before your group plan considers the claim. This should make the process faster and easier for employees.

The Ontario government is looking at eliminating some OHIP coverage for Ontarians travelling outside of Canada but it is a move that will not change coverage for the overwhelming majority of citizens, the government says.

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